Incontinence and Male GU Flashcards by Sarah Gillen

a CYP17 inhibitor that selectively blocks androgen synthesis while increasing mineralocorticoid synthesis and decreasing glucocorticoid synthesis; unlike GnRH agonists/antagonists, it also suppresses adrenal synthesis of androgen

abiraterenone

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neurotransmitter of the pelvic nerve that promotes bladder contraction

ACH

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reduces sexual inhibitions but a frequent cause of male sexual dysfunction

alcohol

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PGE1 formulation that can be injected into the corpus cavernosum or administered as a transurethral pellet to cause an erection

alprostadil

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cell layer present in normal prostate glands that is absent in prostate cancer

basal

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administered to augment the immune response against urothelial cancers to hopefully decrease the rate of recurrence

BCG

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deformity in which the testes lies horizontally, carries an increased risk for testicular torsion

bell-clapper

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antiandrogen that has become the drug of choice due to once daily dosing

bicalutamide

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cigarette smoking, arylamine exposure and shistosome haematobrium are among the risk factors for this

bladder carcinoma

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refers to androgen-sensitive periurethral nodules of prostrate stromal and epithelial cells that compress the urethra and can project into the bladder

BPH

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aggressive testicular cancer, often causes no testicular enlargement; characterized by big multinucleated syncytiotrophoblasts and polygonal cytotrophoblasts with clear cytoplasm and one nucleolus, and hCG as a marker

choriocarcinoma

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confers protection against penile squamous cell carcinoma, which is rare in US but has 10-20% incidence elsewhere (associated with HPV type 16 & 18)

circumcision

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important complexer of calcium in the urine, low levels increase the risk of calcium stone formation; fruit juices are among the remedies

citrate

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this of tamsulosin and dutasteride works better than either agent alone for treatment of BPH

combination

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genital warts caused by HPV

condyloma acuminatum

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failure of the testes to descend, has incidence of ~1% at 1 yr; carries increase risk of germ cell tumors

cryptorchidism

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inflammation of the bladder, common in women of reproductive age

cystitis

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GnRH antagonist, potentially the preferred choice for initial androgen ablation therapy since cost is comparable to GnRH agonists and it is able to suppress LH/FSH release without an initial surge

degarelix

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abbr. for active form of testosterone in prostate, generated by 5-alpha-reductase

DHT

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can be a consequence of BPH, this pouch-like evagination through the muscularis mucosa of the bladder is a site of urinary stasis and therefore prone to infection

diverticula

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cytotoxic anticancer drug used to treat castration-resistant prostate cancer, inhibits mitosis

docetaxel

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testicular carcinoma characterized by poorly demarcated cells arranged in alveolar/tubular patterns or sheets punctuated by foci with hemorrhage or necrosis

embryonal

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uncommon malformation in which the urethra opens on the upper aspect of the penis, seen in association with bladder extrophy when the anterior abdominal wall fails to develop properly

epispadias

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occurs in ~10 min when papaverine and phentolamine are self-injected into the corpus cavernosum

erection

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unusual drug used as palliative therapy for advanced prostate cancer, it is comprised of estradiol and nitrogen mustard and concentrates in the prostate where it disrupts mitosis

estramustine

5-alpha-reductase inhibitor, suppression of DHT production treats BPH by causing regression f the prostate epithelial tissue that is compressing the urethra; side effects include gynecomastia

finasteride

increasing intake of this is the most important preventative measure against kidney stone formation for most people

fluids

antiandrogen used to block initial flare when GnRH agonists are administered to patients with advanced prostate cancer, also combined with GnRH antagonist to produce a "complete" androgen blockage when patients have failed to respond to GnRH agonist alone

flutamide

responsible for the vast majority of malignant testicular tumors

germcell

grading system used in prostate cancer, the sum of the two most common glandular patterns observed

gleason

loss of this, typically unilaterally, has been associated with PDE5 inhibitor use; the permanence of this loss is unclear

hearing

presumed precursor of prostate carcinoma, has normal architecture with patchy basal layer and cytological atypical secretory cells (i.e., have large nuclei with prominent nucleoli)

HGPIN

among the causes of hypercalciuria

hyperparathyroidism

population among elderly men who might derive additional benefit from use of a drug such as terazosin to treat BPH

hypertensives

among causes of this is chemotherapeutic treatment of malignancies

hyperuricosuria

high grade papillary urothelial carcinoma and carcinoma in situ are most likely to do this the bladder

invade

provides information on kidney stone size and location, if it is radiolucent or radiopaque, and information on calculus movement over time

KUB

GnRH agonist administered to desensitize the pituitary gland so that it does not secrete LH and FSH to stimulate testicular androgen production in patients with advanced prostate carcinoma; after an initial flare due to prostate stimulation it causes chemical castration

leuprolide

cells in testis stimulated by LH and FSH to secrete testosterone

leydig

rare testicular tumor, forms a circumscribed golden brown nodule that elaborates androgens and other steroid hormones; cells are large with eosinophiic cytoplasm and may contain Reinke crystals

leydig cell tumor

if a characteristic of prostate cancer, surgery and radiation are treatment options

localized

yellow lesions found in bladder of typically immunocompromised patients with a chronic infection, associated with macrophage accumulation and characteristic Michaelis-Gutmann bodies seen on H&E stained sections

malakoplakia

form of prostate cancer for which hormone deprivation therapy and chemotherapy are the only treatment options

metastatic

on the market since 2012, this beta3 agonist treats urge urinary incontinence by promoting relaxation of the detrusor muscle

mirabegron

characteristic of many urothelial bladder tumors at presentation

multifocal

refers to a rare but irreversible impairment of vision associated with the use of PDE5 inhibitors

NAION

neurotransmitter of hypogastric nerve that promotes bladder storage

use of PDE5 inhibitors is absolutely contraindicate in patients treating angina with these drugs

nitrates

characteristic of prostate cancer disseminated to bone

osteoblastic

normally poorly absorbed from intestine, but absorption is markedly increased by inflammatory bowel disease and can contribute to stone formation unless chelated in the bowel by calcium or magnesium supplements

oxalate

an M3 selective antagonist, it is among the drugs in this class used to treat urge incontinence by blocking parasympathetic stimulation of the detrusor muscle

oxybutynin

perhaps the only symptom of urothelial carcinoma

painless hematuria

pathognomonic of prostate cancer

perineural invasion

DRE-palpable region of prostate that is site of majority of prostate cancer

peripheral

an erection lasting longer than 6 hrs, this is painful and can permanently damage the penis

priapism

normally a walnut-sized gland through which the urethra passes, composed of 70% glandular epithelial cells and 30% fibromuscular stromal cells

prostate

gritty/firm tan mass containing prostate glands lined with a single layer of epithelium

prostate adenocarcinoma

most common non-skin cancer in men, risk of developing is high during lifetime, but risk of dying from it is relatively low

prostate cancer

generally a result of poor bladder emptying or high pressure voiding due to BPH

prostatitis

promotes semen liquefaction, widely used to screen for prostate cancer but role is controversial

PSA

alpha adrenergic agonist that is a common OTC decongestant, it can increase urinary sphincter tone to decrease stress incontinence

pseudoephedrine

somatic nervous system nerve that contracts the external urinary sphincter

pudendal

extension of this from slightly above the iliac crest to the ipsilateral testis indicates the kidney stone is in the ureter

referred pain

rod-shaped structures found in leydig cells/tumors

Reinke crystals

probably more likely to be discovered now as an incidental finding on a radiograph than by the classic triad of flank pain, hematuria, and flank mass

renal mass

consequence of alpha-1a blockade in prostate

retrograde ejaculation

lymph nodes that are a common site of spread for testicular neoplasms

retroperitoneal

herbal remedy widely used to treat BPH, evidence of benefit is lacking

saw palmetto

contribute ~70% of ejaculate

seminal vesicles

most common germ cell tumor, presents as a painless testicular mass; cells are large and round/polyhedral with a distinct membrane, water-appearing cytoplasm, and a central nucleus with 1-2 prominent nucleoli, arranged in sheets with fibrous septations and lymphocyte infiltrates

seminoma

the nurse cells in the testes that support sperm production

sertoli

usually a hormonally silent benign testicular mass

sertoli cell tumor

phosphodiesterase type 5 inhibitor, it provides for a harder and longer-lasting erection by potentiating the effects of cGMP generated by sexual arousal

sildenafil

a very expensive customized therapy used to prolong the life of patients with hormone-refractory prostate cancer; macrophages are harvested and treated to express a prostate cell protein in their MHC surface molecule prior to readministration to patient to no trigger T-cell mediated killing of prostate cells

sipuleucelt

can occur in bladder due to injury/irritation

squamous metaplasia

class of drugs well-known for its adverse effects on sexual performance

SSRI

urinary incontinence due to inadequate containment by the urinary sphincter such that coughing, laughing, lifting heavy objects, etc. causes urine leakage; most common form of incontinence in women

stress

decreased when a urothelial bladder tumor has invaded into the muscularis propria

survival

alpha-1a subtype selective blocker that treats BPH by blocking constrictor tone of the fibromuscular portion of the prostate gland that could be impeding flow; doesn't shrink prostate size; also used facilitate passage of kidney stones

tamsulosin

testicular tumor composed of a heterogeneous mix of differentiated cells including glands, cartilage, hair, bone/teeth, smooth muscle and squamous mucosa

teratoma

kept at a temperature 2-4 deg C cooler than core body temperature

testis

refers to twisting of the spermatic cord, causes abrupt/severe scrotal pain; a surgical emergency

torsion

zone of prostate that is site of benign prostatic hyperplasia

transitional

abbr. for gold standard surgical treatment of BPH, use is decreasing due to better pharmacologic treatment options

TURP

intrinsic causes of its potentially very painful obstruction include calculi, stricture and tumors while extrinsic causes include pregnancy and endometriosis

ureter

obstruction here is a congenital anomaly that is the most common cause of (typically unilateral) hydronephrosis in infants

ureteropelvic junction

urinary incontinence associated with hyperactivity of the detrusor muscle, treated with muscarinic antagonist and/or a beta3 agonist

urgency

kidney stones composed of this are more likely to form at low urine pH

uric acid

4-6 cell layers thick, it rests on a well-developed basement membrane, has a surface layer of large flattened "umbrella" cells, and is a frequent site of neoplasia

urothelium

site in addition to UPJ and crossing of iliac vessels where kidney stones are likely to become lodged

UVJ

more than 1 of these increases the risk of stress incontinence in women

vaginal delivery

common site of disseminated prostate cancer

vertebrae

testicular tumor most common in infants and young children, may contain Schiller-Duvall bodies (have mesodermal core with central capillary and visceral/parietal layers suggestive of primitive glomeruli)

yolksac